4D's

• Abnormalities can be defined using the 4D’s: Deviance, Dysfunction, Distress and Danger.
• Deviance is defined as not conforming to social norms.
• Abnormal behaviour which does not conform with unwritten rules of how people should behave includes schizophrenia and self-harming.
• When it doesn’t work, eccentrics and people with poor social skills are examples of individuals whose behaviour deviates from social norms.
• Dysfunction is defined as a person who cannot function properly due to their symptoms, stopping them from fulfilling their role, duties or obligations.
• Examples of dysfunctional behaviour include OCD or phobias which interfere with everyday life and depression which stops people from holding down a job.
• When it doesn’t work, cognitive impairments, disabilities, Alzheimer's, and lack of social skills are examples of conditions that can lead to dysfunction.
• Distress is defined as a person being in substantial emotional pain or anxiety, which can manifest as physical symptoms such as heart palpitations and hyperventilating.
• Many mentally ill people are in deep distress, fearing hallucinations in the case of schizophrenia, and phobias and depression can cause severe distress.
• Distress can also be a normal reaction to negative events such as bereavement.
• Danger is defined as behaviour which poses a danger to oneself or others, which can lead to the person being ‘sectioned’ (detained under the mental health act), for example, dangerous mass murderers and hallucinations which tell you to hurt other people.
• When it doesn’t work, most mentally ill people don’t pose a greater danger to others than non-mentally ill people, and many ‘sane’ people do activities which are dangerous such as free climbing.
• Stowell-Smith and Mckeown (1999): Analysed psychiatrists’ reports on schizophrenics.
• The rate of incidence for Afro-Caribbean people in the UK is 7%.
• To stop someone posing a danger to themselves may be an infringement of their personal freedom
• These differences are likely to be caused by aspects of certain cultures which make people respond to situations in a certain way.
• Only 20% of sufferers receive a diagnosis of schizophrenia.
• Eating disorders and depression are virtually unheard of amongst very poor people in the third world, but are only widespread in ‘developed’ countries.
• White patients: reports focused on traumas and their emotional state.
• Black patients: reports focused on danger posed by patient.
• The rate of incidence in the West Indies is also 1%.
• The rate of incidence of schizophrenia in Britain overall is 1%.
• The higher rate of incidence for Afro-Caribbean people in the UK could be due to racism in the UK, or it could be due to Afro-Caribbean people experiencing higher levels of environmental stress in the UK.
• In certain cultures, specific mental disorders can have very negative images, and therefore psychiatrists are less likely to diagnose people with these disorders.
• There is a lack of objectivity in defining how much danger is enough to indicate mental illness.
• Cockrane et al
• This might cause certain races to be more often diagnosed with certain disorders.
• If someone poses a danger to others, it benefits society to exclude them or reduce that danger through treatment.
• Some cultures seem to be particularly prone to certain mental disorders.
• There may well be racism and prejudice even amongst mental health professionals, as there often is amongst other parts of society.